Smokers Have Other Problems Besides, Well, Smoking

If you work in the North, you’re familiar with the scene: patients in gowns, riding wheelchairs and trailing IV pumps scrambling over snow banks and icy walkways and braving frostbite-inducing winds to get off hospital property to have a smoke. I suppose for most of my readers, the image will induce a great big “Meh.” But a new article in the Canadian Medical Association Journal suggests otherwise, and that smokers who need to exit the hospital to smoke face special risks and little support in managing their addiction. Money quote:

Study findings affirm evidence that tobacco dependence treatment is inconsistently offered in hospitals and heath providers were uninformed about tobacco dependence treatment, despite availability of nicotine-replacement therapy at study sites. This treatment gap is perplexing, especially as within Canada there exists an evidence-based hospital tobacco dependence treatment program. Unintended patient safety consequences of smoke-free property necessitate effective tobacco dependence treatment during a stay in hospital simply as a risk-management action. Moreover, a health-promoting policy that causes patients to face diverse safety concerns (treatment disruption, infectious disease contact, exposure to adverse weather and possible violence) projects a contradictory health message.

Not helping, of course, are the usual (and sometimes, let it be said, judgemental) opinions of heath care professionals who view smokers adversely and see them as the authors of their own problems.* They tend to take the somewhat cavalier position that if smokers want to go outside for a cigarette, well, that’s their lookout. Elderly woman who falls on ice and fractures a hip while out for a puff? Hell, she brought it on herself by smoking! But is it actually humane to send sick people to the curb in the winter to tend to their addiction? Is it consistent with good nursing practice? And what about the liability and duty-to-care?


*I will never forget the physician who told a young, pain-wracked lung cancer patient that she was responsible for her suffering, and that she should go home and “deal with it.” But some HCPs like to play the blame game in general and especially with patients with addictive behaviours.


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  1. #1 by Boris on Wednesday 02 November 2011 - 1840

    I walk past the UofA hospital everyday and have been hospitalised there twice. I used to wonder why the hospital tolerated patients like those you describe smoking right under the no smoking signs outside the main doors. Anyone entering or leaving the facility would have to brave a cloud of cigarette smoke to enter or leave the building. But then, there really is no place for smokers to go where they won’t be blocking some exit. You raise a very interesting point.

  2. #2 by Cathie from Canada on Thursday 03 November 2011 - 0236

    People act like walking through a cloud of cigarette smoke is akin to cyanide gas. It’s not, of course. For non-smokers, it’s mildly uncomfortable. We breath more carcinogens in a garage or on a downtown street corner.
    Hospitals seem to think they are doing something to contribute to public health by going on these anti-smoking crusades, when what they should be doing is hiring more nurses and opening more surgical beds.
    But what do I know, I’m only a civilian who used to smoke.

  3. #3 by Boris on Thursday 03 November 2011 - 0618

    Cathie, I’m not sure I’d call it mildly uncomfortable. I sympathize with the addiction part, but I find cigarette smoke very acrid (stings my eyes) and foul smelling. I can smell it on my clothing for the rest of the day if I pass through a cloud of it. I’ve never been a smoker and so perhaps I’m a little more sensitive to it than those who have been. I’d gladly stand on a street corner.

  4. #4 by Jenn Jilks on Friday 04 November 2011 - 2128

    Excellent commentary, thoughtful.
    I have a home care client, with squamous cell carncinoma, and a hole in his neck where you can see his carotid artery. He was sent back to hospital because he had maggots in his wound. If he were able to smoke while dying in hospital, he would be better cared-for, have clean sheets, clean pillow cases, his wounds would be changed and bandaged properly. His son and the system wouldn’t be so stressed. He should be clean and cared for, but since he wants to smoke, he is fighting all of us to remain in his own, filthy apartment. PSWs don’t change his bedding. Son doesn’t do laundry. Nurses leave needles on the floor, until I complained to my supervisor. My most difficult placement in a long time.

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